In the healthcare industry, test are often administered in order to classify a patient with a certain condition or to qualify a patient for a certain treatment. Such a test may be administered by a physician, but often is administered by a technician. The technician may be under the employment of a hospital or doctor's office, or in the alternative, may be under the employment of a third party that has an interest in servicing the potential patient. It is in these latter situations that it becomes particularly important to have a fail-safe test administration method with safeguards against fraud. However, of course, such an identification system may be used in a number of situations, and is not restricted to those scenarios described.
The following is one example of how the current process works to order oxygen treatment for a patient. The patient visits a physician. The physician will take a patient history and will determine a diagnosis and determines the need for a patient to have oxygen treatment. In most cases a patient will tell the physician they are experiencing shortness of breath or some other oxygen related ailment. The physician may ask the patient to take a pulse oximetry test to determine if they are in need of oxygen treatment. If the patient pulse oximetry test shows that the patient is in need of oxygen treatment the physician will prescribe oxygen for the patient. To be reimbursed via a payor source (insurance company, Medicare, Medicaid, etc.), a third party Independent Diagnostic Testing Facility must test the patient and submit the test results to the physician. The physician must submit a CMN (Certificate of Medical Necessity) along with the patient's test results to the payor source for reimbursement.
Identification means in such a scenario are known in the art. For example, U.S. Pat. No. 6,643,531 to Katarow discloses a combination fingerprint and oximetry device. U.S. Pat. No. 5,719,950 to Osten, et al. discloses a biometric, personal authentication system. Other patents and publications that may be of relevance include: U.S. Pat. No. 6,537,225, U.S. Pat. No. 6,181,808, U.S. Pat. No. 6,141,436, U.S. Pat. No. 6,094,589, U.S. Pat. No. 6,088,585, U.S. Pat. No. 5,876,926, and U.S. Patent Application No. 2002/0125991.
Despite the testing and identification procedures known in the art, potential for fraud exists in the pulse oximetry business. Healthcare groups such as Medicare have established that they will reimburse for oxygen required by any patient whose pulse oximetry test results fall below the threshold of 89%. Because pulmonary disease is degenerative and never improves, under current Medicare standards, once a qualifying reading has been taken on a patient, that patient is considered a candidate for oxygen for the rest of their life. Clearly, it is in the interest of a provider of oxygen that its patients have qualifying readings.
In an effort to establish that a patient has a pulse oximetry below the threshold of 89%, some test administrators may have submitted test results from other patients that are known to be below the threshold, thereby falsifying the records, rather than submitting the test results of the actual patient that may not fall below the threshold. Such falsification and fraud before payor sources (i.e. Medicare, Medicaid, third party payor sources, etc.) could be eliminated with a sufficient patient identification system in place.